Washington -- Unless Congress acts soon, the New Year will bring plenty of misery for Connecticut's doctors.

On Dec. 31, a temporary measure known as the "doc fix" will expire, resulting in a 30 percent decrease in fees to all doctors who treat patients through Medicare, the government-run health program for the elderly, and active and retired members of the military who are covered under the government's TRICARE program.

"This would basically result in a collapse of our ability to provide care," said John Foley, a cardiologist in Norwich and president of the Connecticut State Medical Society.

Foley said that 37 percent to 40 percent of Connecticut's doctors would stop treating Medicare and TRICARE patients if their fees are slashed.

That would affect many in the state. Connecticut has more than 563,000 Medicare beneficiaries and more than 50,000 active and retired members of the military and their families who are covered by TRICARE.

The perennial panic over the "doc fix" is the result of a formula created by Congress in 1997 that calculated increases in Medicare and TRICARE physician payments on the overall economic growth of the nation. But there's one big problem with this approach: Health care costs have outpaced the nation's economic growth, leaving a multi-billion-dollar shortfall in payments to doctors.

So every year, and sometimes every few months, Congress must appropriate additional money to pay doctors.

Foley, and most fellow physicians, are frustrated by Congress' short-term solutions. They say it's hard to run a business with the uncertainty.

"Congress...tends to kick the can down the road, and we don't want another six- or 12-month [doc fix]," Foley said.

The blame, Foley said, is "poor leadership in Congress."

American Medical Association Executive Vice President James Madara called the short-term solutions a "zombie fix."

"It keeps on coming back from the dead each year in worse and worse form... and you go through that year after year, and you're uncertain, it puts practices at risk and frankly puts our elderly at risk," he said.

Rep. Joe Courtney, D-2nd District, and other lawmakers are pressing for a permanent solution to the problem. They are backing a bill, introduced by Rep. Allyson Schwartz, D-Pa., that would freeze doctors' pay for one year, then give them annual raises for the next four years.

During that time, the Centers for Medicare and Medicaid Services would have to find a new way to pay doctors. Physicians would be penalized for ordering unnecessary tests and procedures for their patients under the plan. But the cost of the permanent doc fix would be high -- as much as $300 billion.

Courtney and other backers of the permanent fix say the money could be found in funds appropriated for the wars in Iraq and Afghanistan that are likely to be left unspent as those conflicts wind down and troops are withdrawn.

Trouble is, there's a lot of competition on Capitol Hill for that pot of money.

Backers of the bill are also hopeful the permanent solution to the doctors' problems can be part of a grand compromise Congress must reach to avoid a "fiscal cliff" at the end of the year.

"The question is, can we get people to focus on this intelligent approach?" Courtney asked.

There will be few other chances to approve legislation in the current lame duck session of Congress. But some say that Congress' bitter partisan fight over spending and taxes needs no additional controversy.

Meanwhile, doctors such as Foley, who works in a practice that employs 40 people and says that at least half of his patients are on Medicare, are concerned about small practices like his being able to stay in business.

"As a state we are still lucky enough to have many small- and medium-sized practices," he said. "But for how long?"

If you kind of line them up...the bankers, the Wall Street crowd, the doctors, the medical business folks....everyone with money on the bad end of the business situation right now....need to line up and pay campaign fund boxes. Both 2013 and 2014 ought to be banner years as folks get lots of cash to influence the 2014 election.

It looks more and more that conservatives will get far more of what they want if the fiscal cliff happens, then if the Republicans compromise on anything.

In this case, for those people truly dependent on Medicare, they will quickly be shifted to Medicaid. However, for people of means, it means that they will have to pick up the tab for their own medical care.

Importantly, if people pay for their own medical care, the *price* of that medical care quickly drops by about 50% or more, which is currently consumed by the Medicare *system*.

Harsh, but important medicine, to get people to realize that Medicare is costing a LOT more than it is providing.

3
posted on 12/01/2012 9:07:02 AM PST
by yefragetuwrabrumuy
(Pennies and Nickels will NO LONGER be Minted as of 1/1/13 - Tim Geithner, US Treasury Sect)

Wait, weren’t the cost savings in Obamacare predicated on this rate cut? If so, then let it stand. Let people start feeling what they have wrought. More importantly, let their representatives get an earful.

:Medicaid says, We don't care what it costs, because we give you so much business we'll give you $250 or you can't treat Medicaid patients anymore."

Being sarcastic of course, say the good doctor can do two procedures in one hour of actual work time, At the Medicaid rate of $250 per procedure as in the example, that good doctor would be paid $500 per hour by the program with the lowest reimbursement rate. Just something to think about.

for those people truly dependent on Medicare, they will quickly be shifted to Medicaid. However, for people of means, it means that they will have to pick up the tab for their own medical care

To qualify for Medicaid in Ohio you cannot have more than 1500 dollars to your name including all assets. If you have a car, much less a house, however humble, you can't have medicaid. By your reasoning, if you have a car worth two grand, you are a "person of means" who can "pick up the tab for your own health care."

Physicians would be penalized for ordering unnecessary tests and procedures for their patients under the plan. But the cost of the permanent doc fix would be high — as much as $300 billion.

Two points - one, beware when the government decides what an “unnecessary” test and procedure is. When it’s the payor who decided this instead of the physician and patient rationing of care will follow and, already is with Medicare. Currently the govt. panel has announced that doctors should not do any mammograms on women for screening for breast cancer prior to age 50... unfortunately there are a lot of women with breast cancer prior to that age that will go undetected !! Also they have determined that doctors should not screen for prostate cancer...and of course that learned panel had no urologists, nor oncologists !!

Two — doctors offices are no different that any other business. They must cover expenses and turn some profit to stay in business... the profit margin in caring for a medicare patient currently is negligible to nil and when the feds cut reimbursements further doctors have two choices...refuse to see medicare patients, or close the doors...the number opting out right now is high...it will skyrocket if congress doesn’t fix this before implementation. If you have a doctor that is seeing you and taking your medicare...do not move, do not change doctors...and thank your lucky stars..and his/her office!

first it would really be hard do two of those in an hour even if the actual time spent looking into the patient was 30 because of time spent making sure the patient is fully prepped and sedated(even though there are preparers and an anesthesiologist) and then comes out of the anesthesia in good condition, and even if he could it would mean two separate operating rooms ready to go at the same time cause you simply can't wheel one patient out and another in like a conveyer belt

second, do you think that all goes into his pocket? try figuring Malpractice Insurance, insurance, computers, rent and utilities for his office, salaries and insurance for those that work in said office, etc into that equation... not to mention if he is still paying off doctor school loans

even at $500 an hour it goes pretty quickly since they don't operate all day every day

and yeah, that same model works on office visits too so for a $65 office visit they pay ~$15

When doctors can’t pay their malpractice insurance, the the Democrat lawyers don’t get paid - then Obama and Congress will do something. In the meantime, elderly on Medicare and retired veteran heroes on TRICARE can suffer and die for all the Democrats care.

“Very soon the left will turn their venom towards doctors and other healthcare providers. Its coming......”

That happened long ago. They were just somewhat stealth about it. If you want to know what the consequences of imposed socialism are to the moral and motivation of a society, look no further than American physicians. The only ones who are relatively happy at this point are those who have higher level hospital roles - with at least a portion of their salary paid by the administration. This isn't about being rich. Few doctors are - and that's a fact. This is about self-determination and having a reasonable expectation to benefit from years of sacrifice and hard work.

I must point out to the self-satisfied left. When you hurt others while playing out your own resentments, you create more resentment. Eventually, this game leads to bad things for everyone.

This is a global fee. It includes preoperative workup, the procedure and postoperative care for 90 days. Can easily entail five hours of physician work. Now you’re down to $100 an hour, out of which must come overhead, typically at least 50%. Now you’re down to 50/hr or less. Try getting that rate from a lawyer or even a mechanic. Try to convince a bright young student to take on a few hundred k in debt and at least 11 years of training for that.

I know all to well as I work in the financial side of a multi-specialty practice.

I was being sarcastic but there is some validity to my point. The current system is financially unsustainable now and in the future. There is simply not enough tax revenue to support current payment levels. Rationing may be inevitable, but I would rather see market forces decide the issue rather than the government. Of course there are no free markets in health care but that is another thread.

I take it from your screen name that your are or were a physician in the military, and for that I thank you for your service.

I think if a doctor refuses to see medicare patients , the Feds will make sure this doctor doesn’t get a license to practice in that state. The Feds will be issuing licenses soon, not the state.
Just you wait and see as Rush always says.

They don’t want to fund the great society healthcare programs, they have been raiding them. So IMO they are going to order them to work for far less or they will give them a salary and that will be the end of it.

Disclaimer:
Opinions posted on Free Republic are those of the individual
posters and do not necessarily represent the opinion of Free Republic or its
management. All materials posted herein are protected by copyright law and the
exemption for fair use of copyrighted works.